Provider Demographics
NPI:1114255965
Name:MYERS DERMATOLOGY LLC
Entity Type:Organization
Organization Name:MYERS DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-205-1914
Mailing Address - Street 1:5701 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5181
Mailing Address - Country:US
Mailing Address - Phone:337-456-3323
Mailing Address - Fax:337-456-4638
Practice Address - Street 1:5701 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5181
Practice Address - Country:US
Practice Address - Phone:337-456-3323
Practice Address - Fax:337-456-4638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD202110207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty